asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2025-007asurgery-555Research ArticleОБМЕН ОПЫТОМEXCHANGE OF EXPERIENCE | PRACTICEИзменение подходов к лечению стеноза внутренней сонной артерииA shift of treatment approaches in internal carotid artery stenosishttps://orcid.org/0000-0002-2383-4214ХоревН. Г.KhorevN. G.

Хорев Николай Германович, д.м.н., профессор, заведующий кафедрой кардиологии и сердечно-сосудистой хирургии с курсом дополнительного образования, 

656038, Барнаул, проспект Ленина, д. 40;

Nikolai G. Khorev, Dr. Sci. (Med.), Professor, Head of Department Cardiology and Cardiovascular Surgery with a Course of Continuing Professional Education,

40, Lenin Ave., Barnaul, 656038

xorev-ng@mail.ruАлтайский государственный медицинский университетРоссияAltai State Medical UniversityRussian Federation202509062025221278286Copyright © Хорев Н.Г., 20252025Хорев Н.Г.Khorev N.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/555

Целью данного обзора являются представление и обсуждение научной литературы для обоснования принятия решений оптимального выбора метода профилактики и лечения пациентов с атеросклеротическим стенозом внутренней сонной артерии. Анализу подвергнута эволюция подходов в лечении заболевания за последние 3–4 десятилетия. Приведено обобщение доказательной базы относительно эффективности, безопасности хирургических и медикаментозных методов профилактики инсульта у симптомных и асимптомных больных со стенозом внутренней сонной артерии. Сделаны выводы относительно текущих приоритетов в выборе профилактики инсульта у больных со стенозом внутренней сонной артерии. В обзоре анализируются текущие рандомизированные исследования и объясняется, почему они вряд ли определят рутинные показания для различных операций на сонной артерии. Ранее проведенные рандомизированные исследования показали эффективность каротидной эндартерэктомии в снижении риска инсульта. Однако не все пациенты получили пользу от вмешательства, особенно бессимптомные больные. У каждого конкретного пациента обычно невозможно быть уверенным в причине инсульта или транзиторных ишемических атак. Определение факторов риска и вероятности ишемического события более применимо в диагностике и лечении. Обсуждаются соответствующие мировые рекомендации относительно вмешательств на сонных артериях, в том числе способы их улучшения. Краеугольным камнем профилактики инсульта является оптимальная лекарственная терапия, поскольку эта процедура неинвазивна и защищает от тяжелых осложнений атеросклероза в различных сосудистых бассейнах у больных в группе риска. Остается важным вопрос, приносит ли хирургическое вмешательство на сонной артерии пользу пациенту в современную эпоху, и если да, то для кого?

The purpose of this review is to objectively present and discuss the scientific literature that is critical for decision-making on the optimal choice of prevention and treatment method for patients with atherosclerotic stenosis of the internal carotid artery (ICA). The evolution of approaches to the treatment of the disease over the past 3–4 decades is analyzed. A summary of the evidence base regarding the efficacy and safety of surgical and drug methods for the prevention and treatment of stroke in symptomatic and asymptomatic patients with ICA stenosis is provided. Conclusions are made regarding the current priorities in the choice of stroke prevention and treatment in patients with ICA stenosis. The review analyzes current randomized trials and explains why they are unlikely to determine routine indications for carotid artery procedures. Previous randomized trials have shown the effectiveness of carotid endarterectomy in reducing the risk of stroke. However, not all patients benefit from the procedure, especially asymptomatic patients. In any given patient, it is usually impossible to be certain of the cause of stroke or transient ischemic attack. Relevant global recommendations for carotid artery procedures, including ways to improve them, are discussed. Conclusion: The cornerstone of stroke prevention is optimal medical therapy, as this procedure is noninvasive and protects against all complications of atherosclerosis in various vascular beds in all at-risk individuals. The important question remains whether carotid surgery is beneficial to the patient in the modern era, and if so, for whom?

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The authors declare that there are no conflicts of interest present.